Once diagnosis is complete, Sutter Sleep Disorders Centers sleep medicine specialists will design a treatment plan exclusively tailored to the patient’s needs. Because each patient is unique and the causes of disturbed sleep vary greatly, treatments may range from behavior changes to medication to use of sleep-aid devices. Common treatments may include:

• Follow Sleep Hygiene rules
• Medications
• Continuous Positive Airway Pressure (CPAP)
• Auto-Adjusted CPAP Titration
• Bi-level Positive Airway Pressure
• Varied Positive Airway Pressure
• Patient Teaching and Titration
• Complementary Medicine
  

Sleep Hygiene Rules

• Establish and maintain a daily schedule of activities every day of the week. Try to eat at regular times. Keep the same bedtime hours even through the weekend. Keep a regular wake-up time each morning, no matter what time you went to bed the night before. You should maintain this wake-up time regardless of how poorly you slept the night before. This is the strongest signal you can give your internal clock to set the circadian rhythm. Eventually the body adjusts to this schedule, which leads to a regular time of sleep onset.
• Do not stay in bed extra time in the morning. Staying in bed for excessively long times can lead to fragmented and shallow sleep. Trying to make up for lost sleep causes the circadian rhythm to be delayed by several hours and you will not be able to sleep at your desired time the next night. You may be starting a vicious cycle of poor sleep. Reducing the time spent in bed can be beneficial because you are more likely to become sleepy at the desired time the next night.
• Limit naps during the day, particularly if you are a poor sleeper. Naps usually reduce the amount of sleep you need at night, causing difficulties falling asleep or light sleep.
• Maintain a regular daily program of exercise at an appropriate time. If you are a particularly poor sleeper, try to take to exercise in the late afternoon or early evening. However, do not exercise vigorously right before going to bed--your system may become too stimulated to relax and you will have difficulty going to sleep.
• Approach bedtime as relaxed as possible. Plan to spend your evening winding down from the activities of the day by doing something enjoyable and relaxing. Too many people view the day’s problems and tomorrow’s plans. This stimulates your mind and prevents sleep. At the bedtime hour, chances are that you cannot take any action to resolve work or other problems, so you are only creating anxiety by thinking about them. Discipline yourself not to think upsetting thoughts in bed--be prepared to consciously replace them with pleasant and relaxing thoughts.
• Establish a routine transition period to prepare for your bedtime and do it daily, even when traveling. Set aside some time for gradual unwinding from the stressful events of the day. One sleep clinic advises that you make a list of things to do for the next day so that you don’t stay awake thinking of unfinished business. Also establish regular bedtime rituals such as locking the door, turning down the heat, taking a warm bath, and brushing your teeth. Once in bed, establish a routine for relaxation--closing your eyes, getting comfortable in bed, and thinking of tranquil mental images.
• If you cannot fall asleep easily, get out of bed and do something different. Remember that it should not be an activity that is strenuous or stimulating. Try to select an activity such as reading that will prepare you for relaxation and sleep.
• Make your bedroom conducive to sleep. Use a mattress that is comfortable for you and control light and sound if they disturb your sleep. Avoid either excessively warm or excessively cold rooms as they can cause sleep interruptions. The ideal temperature for sleep is thought to be between 64 and 66 degrees Fahrenheit.
• Avoid using the bedroom for activities unrelated to sleep. You want to associate this particular room with relaxation, so you must break the conditioned association of sleeplessness with the bedroom environment. Watching television, reading, knitting exercising and similar activities done in the bedroom can trigger “wake” rather than “sleep” signals.
• Avoid eating heavy meals prior to bedtime as well as going to bed hungry. Hunger often disturbs sleep, so a light snack or glass of milk will make you feel more comfortable. The amino acid in milk (tryptophan) is thought to help induce sleep and carbohydrates are thought to move it to the brain faster, so a glass of warm milk and crackers may be a ritual that will prepare you for sleep.
• Avoid taking any stimulants before bedtime. This includes coffee, tea, alcohol, nicotine, diet drinks containing caffeine, and food with caffeine derivatives (such as chocolate). People with insomnia often are sensitive even to small doses of stimulants such as caffeine. As for smoking, nicotine stimulates the central nervous system and heavy smokers have been found to sleep more poorly than nonsmokers. If used in moderation, alcohol can be a relaxant. But when alcohol is taken prior to bedtime, sleep can be highly disturbed with many awakenings that decrease total sleep.
• Avoid taking sleeping medications. Sleeping pills are not a long-term solution to poor sleep and their use can aggravate sleeping problems.

The important thing to remember is that can take positive steps to improve your sleep habits. Don’t give up on these rules after only a few nights. The body needs time for the type of conditioning incorporated in these guidelines. And if your daytime worries are affecting your nighttime sleep, you’ll need time to learn the mental habits necessary for relaxation. Remember, hygiene means practicing what is conducive to your health—and good sleep habits are worth the practice.

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Medications
Depending on the patient’s diagnosis, sleep medicine specialists may prescribe medication aimed at encouraging sleep or wakefulness. Medications vary greatly by patient and the sleep disorder diagnosed and should be discussed with the sleep medicine doctor.

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Continuous Positive Airway Pressure (CPAP)
Patients with obstructive sleep apnea often get relief from a device that keeps airways open by gently increasing air pressure in the throat. There are several types of devices. The continuous positive airway pressure uses a single level of air pressure to hold the throat open by keeping the uvula and soft tissue from closing off the airway.

More information on continuous positive airway pressure (CPAP) is available in our Health Information Library.

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Bi-Level Positive Airway Pressure
Bi-level devices use two levels of air pressure to hold the throat open. The first with inspiration to keep the uvula and soft tissue from closing off the airway. The second during expiration at a pressure less than the inspiration. The less pressure allows the patient to breath easier against the machine.

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Variable Positive Airway Pressure
Variable devices vary the flow of the device while a patient inhales and exhales to maintain a constant airway pressure.

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Auto-Adjusted CPAP Titration
While many patients do well on a continuous positive airway pressure (CPAP) device that delivers a constant level of air, others achieve better results from a device that delivers varying amounts of air pressure volumes. At the Sutter Sleep Disorders Centers, patients receive sleep monitoring while testing airway pressure devices to determine the type that works best.

More information on other machines for treating sleep apnea is available in our Health Information Library.

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Patient Teaching and Titration (CPAP)
At the Sutter Sleep Disorders Centers, sleep medicine specialists and technologists help patients select and size the most effective CPAP solution. In addition, patients undergo sleep studies to determine whether the solution chosen is providing restful sleep. Once the equipment is selected, Sutter Sleep Disorders Centers technologists who are skilled at working with CPAP equipment teach patients how to use it effectively and remain available to answer questions.

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Complementary Medicine
Just as the reasons for sleep problems vary, so do the types of treatment available. Some conditions demand medication or medical equipment aimed at correcting a physiological issue, while others resolve through behavior modification or relaxation techniques, vitamin supplements, weight loss programs, or other approaches. Sutter Sleep Disorders Centers sleep medicine specialists work with each patient individually to determine the right treatment and continue treating the patient until the best possible result is achieved.

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